In a report published in ‘Personnel Today’, Kate Summers noted that musculoskeletal disorders (MSDs) were the leading cause of sickness absence and productivity loss in the UK last year.  She went on to explain how support from effective line management could allow those with MSDs to remain in work. Kate Summers explains. 
According to Self-management of chronic musculoskeletal disorders and employment by The Work Foundation, employers need to accommodate the needs of employees with MSDs to avoid their condition worsening and preventing them from falling into unemployment.
The report looks at the self-management of chronic musculoskeletal disorders for those in employment and it found that individuals living with a musculoskeletal condition go to great lengths to personally ensure they are able to continue working. Generally, employers do not ensure that these individuals truly benefit from the psychological, social and economic benefits that attending work offers, which would, in turn, make them happier, healthier and more productive.
The report’s findings present insights and challenges to today’s employers when it comes to managing employees with MSDs in particular, and chronic conditions more generally. A number of employer recommendations were developed from interviews with individuals living with an MSD who were either in work or planned to return to work in the future. These interviews covered the history of their condition, as well as their working lives, and the role that they, and others, played in managing their condition at work.
The term MSD describes any condition that affects the bones, joints and connective tissue, the most common of which is arthritis in its various forms. They are sometimes misunderstood as conditions that affect the elderly, and therefore not of particular relevance to the working-age population. However, in 2013, the Office for National Statistics reported that MSDs were the largest single cause of sickness absence in the UK.
Furthermore, in 2011, 37% of Employment and Support Allowance claimants reported an MSD as their primary health condition. MSDs are therefore highly relevant to the working-age population, and a threat to employers in terms of lost productivity.

What is self-management?

Self-management is a concept gaining increasing attention within healthcare, and is defined in the report as being an individual’s ability to manage the consequences of living with a chronic condition. These consequences are not limited to physical symptoms, but include the psychological, emotional and lifestyle challenges that are inherent to living with such conditions. Individuals have different capacities to self-manage MSDs, and self-management behaviours vary widely from involvement in medical decisions, learning techniques to cope with pain or fatigue, taking appropriate exercise and following a specific diet, or having the ability to set and achieve goals related to the condition. Having patients who are informed about their condition, and who play an active role in managing it, is gradually becoming central to the way that long-term conditions are conceptualised in healthcare. However, how self-management is played out in the context of work is less understood.

Employer responsibilities

Under the Equality Act 2010, employers must make reasonable adjustments to ensure that disabled workers are not seriously disadvantaged when at work. However, the report found that provision of employer adjustments was patchy, and the onus was often on employees to negotiate beneficial changes to the workplace. Employers have a legal obligation to provide reasonable adjustments, but some individuals felt reluctant to ask for support. One said: “I just thought I would try and get on with what I’ve got. I almost don’t want to ask for stuff.”
Another individual described how they were aware of a range of workplace adjustments, but had not asked for some because they felt they had to prioritise what they requested: “I know there are special keyboards and that sort of thing. But I haven’t asked because I’m thinking of maybe going back to four days a week. Would she want to invest in me?”
If employers are more proactive in fulfilling their obligations to employees with disabilities, their workforce would be better equipped to do their jobs. At present, those who are reluctant to seek adjustments are not getting the support they need.

Integrate employees with MSDs into the workforce

Individuals with MSDs often do not want to be considered as “different”, for fear of being judged unable to do their job  properly. This may, in turn, make them reluctant to seek support in managing their condition. There are ways in which employers can avoid “singling out” individuals with MSDs to avoid making them feel vulnerable. For example, with reference to workplace assessments: “It would be great if everybody could get this assessment, regardless of whether not you have a disability… That way, it puts everybody on the same footing.”
Many study participants also spoke about fear of job loss, resulting in a reluctance to talk about their condition with their employer in case it singled them out as less productive or able: “I just feel they’re always judging you because they think you’re not capable at your job if you’re asking for these adjustments. Or they feel that you won’t be able to do you work correctly,” said one.

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Good practice: wellbeing

It is very important that individuals with MSDs do not feel their condition has a bearing on their performance assessments. Line managers should conduct discussions regarding performance completely separately to discussions about supporting the individual and their condition. It may even be necessary to assign one manager to oversee an individual’s performance, and a separate one to lead on providing appropriate support. Developing an employee relationship where individuals are able to communicate honestly about the implications of their MSD at work, and request adjustments so they are seen as a valued member of staff, is also important.

Educate your workforce about chronic conditions

One of the biggest barriers faced by individuals with MSDs is the ignorance of others regarding their condition. This can lead to individuals concealing their MSD and not receiving the support they need, thus compromising the management of their condition. When asked what would improve the management of their condition in the workplace, respondents often stated: “Better awareness; people understanding a bit more about it.”
Charities such as Arthritis Care run arthritis awareness courses which can be delivered in the workplace and may be one way to educate a workforce about MSDs.

Line managers have a key role to play

The role of the line manager is key in either facilitating or impeding an individual’s management of their MSD. Participants with a good line manager felt more supported in the workplace. One employee stated: “She knows my condition, she knows how it affects me, and I think that helps tremendously.”
Although being better informed was identified by participants as being an important step in supporting those employees with MSDs, some line managers appear reluctant to seek out more information about the condition: “I think the managers should have taken it upon themselves to understand my illness better,” says one sufferer.
It is crucial that line managers work hard to build a strong relationship with any employess living with an MSD, and that they take responsibility for becoming more aware of the condition their employee is living with, and how it can have an impact on their role. Line managers must be proactive in asking how employees with MSDs can be supported in their role and be guided by employees in developing mutually beneficial employment solutions.

A call to action for employers

Improving the management and support for employees with MSDs will see employers reaping the benefits of increased productivity, employee engagement and reduced sickness absence. The Work Foundation’s report finds that individuals living and working with an MSD bear too much of the burden of ensuring they are able to manage their condition at work and challenges employers to do more.
Employers have a legal obligation to provide reasonable adjustments to employees with a disability. To enable this, a positive employment relationship is required, where employees feel able to express any concerns they have regarding their MSD at work, and feel that their line manager is supportive, empathetic and reactive if they request necessary appropriate adjustments.
Line managers do not need to be “experts” in MSDs, however an awareness is needed to ensure positive employee wellbeing (both physical and mental) is maintained. Dialogue should also be encouraged to develop mutually beneficial solutions and ensure that employees with MSDs feel valued and integrated into the workforce. This is not new, radical thinking, it is the essence of ensuring the implementation of “good management”. Employees will benefit from improved wellbeing when the pressure to manage their condition at work themselves is removed, and employers will see improved engagement and productivity.

How we can help

Without a good absence management system in place, it is difficult to identify which individuals need support.  Employers do have a duty of care to protect their employees, and by and large the majority of managers and HR personnel want to do their best for their team.

Absence management expert Adrian Lewis of, said:

“absence management has a perception of being the proverbial ‘big stick’, but it is far more about identifying employees who need support than in ‘whipping people’ back to work.  We work on the basis that there are lots of reasons for absence.  Our software Activ Absence helps to identify those who really are in need of support, and by automating many of the mundane tasks, gives the HR Manager more time to use their skills in educating and informing line managers and preparing return to work plans.”

“Self-management of chronic musculoskeletal disorders and employment” by Kate Summers, Zofia Bajorek and Stephen Bevan, was published by The Work Foundation in 2014.
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